The inspection was carried out on 18 and 23 January 2018 and was unannounced on both days. We had previously inspected the home in August 2016 and rated it as good.

Attlee Court is a ‘care home’ for up to 68 people. The home was divided into three units; dementia care, nursing care and residential care. Before the second day of the inspection, the provider combined the units for residential and nursing care. At the time of the inspection there were 43 people in the home. People in care homes receive accommodation and nursing or personal care as a single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We identified five breaches in the regulations relating to person centred care, dignity and respect, safe care and treatment, staffing and good governance. We asked the provider not to admit any further people to Attlee Court and to increase the staffing levels with immediate effect. The provider agreed to do this and we saw this had been initiated by day two of the inspection.

We found staffing levels were insufficient to meet people’s needs and this impacted throughout people's care and support. We saw many instances where people had to wait considerable lengths of time to have their basic needs met.

Staff had a kind and caring attitude towards people they cared for, although they lacked time to spend with people other than when completing personal care. People’s dignity was at times compromised when staff were unable to support them in a timely manner. There was a lack of person centred care because staffing levels prevented staff from responding properly to meet people’s needs. There was little meaningful activity taking place and people remained in their beds or in their chairs for long periods of time.

Staff knew the signs of potential abuse although they did not all feel confident to raise safeguarding concerns, particularly where this was in relation to whistleblowing.

Risks to individuals were not always assessed, recognised or managed safely. Accidents and incidents were recorded but there was poor management oversight and analysis of these. Systems and processes for managing medicines were not robust.

There was poor leadership and management in the home and quality assurance processes were not rigorous enough to monitor practice or identify risks and areas to improve. Systems for communication within the staff team were not always effective or reliable. Staff did not always feel supported to carry out their role and we found information was not always shared in a timely or supportive way.

People enjoyed the quality of the meals and the cook was knowledgeable about people’s individual needs. However, some people's access to drinks was limited and people were not always served drinks when they needed them, such as when they woke in the morning.

People’s mental capacity was appropriately assessed although people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. People were not consistently involved in planning their care. Care plans where completed were up to date, although we found two people’s care records which were blank, which meant staff had no information about how to support these people. Records of people's daily checks and care provided were not completed in a timely way to show when such care was carried out.

The overall rating for this service is ‘Inadequate’ and the service has therefore been placed in ‘Special measures’. Services in special measures will be kept u

The inspection of Attlee Court took place on 17 August 2016 and was unannounced.

Attlee Court provides accommodation and nursing care for up to 68 people. The service has

two floors and provides care and support for people with nursing and residential needs including people who are living with dementia. On the day of our visit there were 23 people living at the home as only a small number of people at a time were being admitted due to previous concerns. This inspection was to consider whether improvements we had seen at our previous inspection had been sustained.

The service did not have a registered manager in post at the time of our inspection although there was a home manager who had been in post since August 2015 and had applied for registration. The home manager was on annual leave on the day we visited; however the area and deputy managers were present. We spoke with the home manager on their return from leave.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were safe and this view was supported by relatives. People felt confident in staff’s abilities and staff were able to explain what action they would take if they found anything of concern. We saw the manager had taken appropriate action in regards to recent concerns.

We found risk assessments were person-specific and contained risk reduction measures to limit the likelihood of harm. Staff received guidance from these assessments as to how best care for people with differing needs, whether this was due to physical or mental health needs. We did highlight to the area and deputy managers that moving and handling risk assessments needed further detail in regards to the method of transferring someone so that staff had specific instructions. They agreed to remedy this promptly.

Staffing levels were sufficient on the day we inspected and we saw staff had time to spend talking to people and the atmosphere was relaxed. It was evident staff were focused on the needs of people in the home at all times.

We observed medicine administration and found concerns around this practice. One person was receiving covert medicine without the necessary authorisation and in addition this medication was crushed without direct medical guidance. We discussed this with the area manager who immediately took action by speaking to the member of staff. The area manager acknowledged our concerns and arranged for the staff member to receive further training and support for this role. The area manager also changed the processes for covert medicine on our guidance.

People were supported with nutrition and hydration, and were able to access health and social care services as required. Care records showed regular visits from chiropodists, social workers and GPs.

We saw that people had Deprivation of Liberty Safeguards in place where their freedom was restricted due to a lack of mental capacity to assess risk, and that decision-specific mental capacity assessments had been competed for all aspects of people’s care needs.

Staff displayed confidence in their role and had access to regular training which was supported by regular supervision. We saw staff had a good rapport with people; they spent time listening to them and displayed a sound knowledge of people’s preferences and routines. Consent was sought each time they supported someone and privacy and dignity were respected.

People were occupied throughout the day with a variety of things to do such as sitting in the garden, playing games and chatting to each other and staff. We observed high levels of interaction during the afternoon bingo game where it was evident there were positive relationships between people.

Care records reflected individual need

We carried out this inspection on 25 April 2016. The inspection was unannounced.

Attlee Court is a nursing home currently providing care for up to a maximum of 68 people. The service has two floors and provides care and support for people with nursing and residential needs including people who are living with dementia. On the day of our visit there were 20 people living at the home and the provider had a voluntary stop on placements.

The service did not have had a registered manager in post at the time of our inspection, although there was a home manager who had been in post since August 2015 and had applied for registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The home manager was on leave on the day of the inspection and we arranged to give feedback upon their return.

Since the last inspection there had been significant improvements in the home. Renovations had been completed and there was more robust management of work being carried out within the home.

The environment was much more welcoming and homely than had previously been found at the last inspection, particularly for those people living with dementia.

The management of risk had improved in relation to the premises and for some aspects of individual people’s care needs. There were some areas of concern in relation to accurately identifying risks from some equipment.

Standards of cleanliness in the home had improved and we found most areas to be visibly clean and free from odours.

Staffing levels ensured people’s physical and social needs were met. There had been some staff changes since the last inspection and changes in senior management had helped to drive improvement.

Medicines were managed appropriately.

Staff were kind and caring, and the quality of interaction with people who were living with dementia had improved since the last inspection.

There were activities and improved resources for people to be meaningfully engaged.

There was improved management oversight in relation to the premises and to individual people’s care needs. Better systems were in place to check the quality of the provision but these were not all robust enough with regard to some aspects, such as safety checks.

We carried out this inspection on 30 November, 02 December and 14 December 2015. The inspection was unannounced.

Attlee Court is a nursing home currently providing care for up to a maximum of 68 people. The service has two floors and provides care and support for people with nursing and residential needs including people who are living with dementia. On the day of our visit there were 26 people living at the home.

The service did not have had a registered manager in post at the time of our inspection, although there was a manager who had been in post since August 2015 and had applied for registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The new manager had begun to make some improvements to the service and feedback from people, staff and relatives was positive. However, we found renovations were being carried out at the time of the inspection and there were no care strategies or risk assessments in place to ensure people’s safety and well-being in relation to the work being done. The management of the refurbishment work was poor and lacked organisation or consideration for associated hazards, such as fire safety.

The premises were in the process of redecoration in response to the previous inspection findings; however, improvements were not complete at the time of this inspection and the environment was not welcoming or homely, particularly for those people living with dementia.

The management of risk was very poor, in relation to the premises and to individual people’s care needs. We discussed this at length with the manager during the first two days of the inspection. However, little action had been taken by the time we arrived on day three and we found continued concerns.

Staff practised appropriate infection control measures, such as cleaning and the use of personal protective equipment. However, there were some aspects of infection control and prevention that were not adequately monitored and standards of cleanliness were not always maintained.

Staffing levels were adequate and people did not have to wait for staff assistance. Staff were confident in how to recognise and report suspected abuse, although policies and procedures did not clearly illustrate how staff should report concerns.

Staff recruitment and vetting was appropriately carried out, but where agency staff were used, suitability checks were not robust. Staff induction was not fully evidenced for new staff.

Medicines were managed appropriately.

The menus had been revised since the new manager came into post and people reported improvements in the quality of the meals.

Information in care plans was easy to locate, however, there was conflicting information in some of the records we looked at. Individual risks assessments for people were not always clearly stated, such as for moving and handling.

Staff were kind and caring, although the quality of staff interaction with people varied. There was little respect for this being people’s home whilst the building works were ongoing.

There were too few activities for people to be meaningfully engaged and as a result, some people were frequently bored or passive.

There was little management oversight in relation to the premises and to individual people’s care needs. Some systems were in place to check the quality of the provision but these were not thoroughly implemented and did not identify concerns we found at this inspection.

The overall rating for this service is ‘Inadequate’ due to the multiple and continued breaches we found. We noted the provider had made some improvements to the service and was still working towards their action plan at the time of the inspection, but progress was slow.

You must start this section with the following sentence; ‘We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This was an unannounced inspection carried out on the 12 and 13 August 2014. At the last inspection in February 2014 we found the provider met the regulations we looked at.

At the time of this inspection the home did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

Attlee Court provides accommodation and nursing care for up to 66 people with the majority of people living with dementia. The home is located close to local amenities in the residential area of Normanton. Accommodation is based over two floors accessed by a passenger lift. All of the bedrooms are single occupancy. Communal lounges, dining rooms and bathing facilities are provided. There is a garden area to the rear of the home for people to use. Car parking is available.

We found people were cared for, or supported by, suitably qualified, skilled and experienced staff. However, appropriate staffing levels were not always maintained and people were not able to eat lunch at the same time of day. This breached Regulation 22 (Staffing), of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This is because the provider had failed to maintain appropriate staffing levels. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005 and how to ensure the rights of people who lacked the mental capacity to make decisions were respected. However, not all the care plans had completed mental health and capacity assessments. We found the service to be in the process of meeting the requirements of the Deprivation of Liberty Safeguards.

Suitable arrangements were in place for mealtimes and people were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. Care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. Care and support was tailored to meet people’s individual needs and staff knew people well. The care plans included risk assessments. Staff had good relationships with the people living at the home and the atmosphere was happy and relaxed.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when they were supporting them. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity. People were supported to attend meetings and complete questionnaires where they could express their views about the home.

A range of activities were provided both in the home and in the community. Staff told us people were encouraged to maintain contact with friends and family.

The manager investigated and responded to people’s complaints, according to the provider’s complaints procedure. However, complaints were not always recorded appropriately.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the manager and provider. Staff were supported to raise concerns and make suggestions when they felt there could be improvements and there was an open and honest culture in the home.

We found a breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We carried out this visit to check if the provider had taken action to address areas of non-compliance raised at our previous inspection visits in April and July.

We observed care in all areas of the home. We spoke with ten people, three relatives, the manager, regional manager, three care staff and the chef.

We focused our inspection closely on people’s experiences in the dementia care units and our specialist adviser, who was a dietician, looked at how people’s diet and nutritional needs were met.

We found the provider had taken steps to improve the environment for people with dementia and had separated the unit into two smaller units. We saw this provided much calmer surroundings for people. However, we remained concerned some people did not receive care appropriate for their needs.

We reviewed documentation which showed people’s care, particularly in relation to nutrition, was inconsistent with gaps in recording within care plans. Although the provider told us they had taken steps to improve and audit care records, we saw these still did not illustrate people’s needs were met effectively.

We found staff were appropriately supported to do their role.

We found that the home had systems which monitored and assessed the quality of service. However we were concerned the areas of non-compliance we identified in the report had not been picked up through these processes. This meant the effectiveness of the quality monitoring systems was not assured.

We carried out this inspection in response to a significant number of safeguarding notifications we had received following our previous inspection on 25 April 2013. The information provided to us was in relation to the dementia unit within the home. Therefore the focus of the responsive inspection was solely in relation to the dementia unit.

At the previous inspection on 25 April 2013 we noticed one person had not received prompt medical attention following an injury. We also saw that care records contained conflicting information with regard to the risk of falls. We asked the provider to send us a report by 22 June 2013 detailing how they planned to meet the essential standards. The provider submitted an action plan and told us they would be compliant by 31 July 2013. Therefore we did not follow this area up but we will do so at a later date. However, at this responsive inspection we found additional areas of concern.

We found people’s needs were not always assessed and care and treatment was not planned and delivered in line with their individual care plan.

We found the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. Although the provider had carried out audits, we found in some areas, such as care records, these audits had not identified the issues we found.

We spoke with people living in the home and they told us they were happy. They said they made their own decisions. One person said "the staff are brilliant, they always ask me what I want to do". We saw that people were supported to make choices and their independence was promoted.

We saw that staff were kind and caring with people and they understood their individual needs. We observed people frequently enaged in conversation with staff. People said they were happy and that they enjoyed good food and a comfortable bed. We noticed one person had not received prompt medical attention following an injury. We also saw that care records contained conflicting information with regard to the risk of falls.

We saw that medicines were stored and administered appropriately overall, with all details recorded. People told us that they got their medicines on time. Staff told us they were confident to give medicines and they understood the medication policies and procedures.

We saw that the first floor had undergone some refurbishment. People and their relatives told us that they thought the home looked smart. We saw that the premises were safe and accessible for people who lived there and for staff. We talked to maintenance staff about ongoing improvements. Staff told us that they knew the procedures to follow in an emergency.

We saw records to show how premises had been maintained and how regular checks were carried out by the manager to ensure quality of care for people.

Prior to our visit we received information alleging that staffing levels in the home were inadequate to meet people’s needs. Particular reference was made to the night shift on the dementia care unit.

On arrival at the home the atmosphere was calm and well organised on both units. We spoke with two people who used the service who were seated in the lounge area of the nursing and residential unit. They said they felt there were sufficient numbers of staff to meet their needs and had no concerns.

Due to communication difficulties we were unable to speak with people on the dementia unit. Instead we observed how people were cared for and how people interacted with each other and staff. People who were up were appropriately dressed and well cared for and we saw how they were treated with dignity and respect by staff.

We spoke with seven members of care staff. They told us they had concerns, particularly during busy times when people needed assistance preparing for bed at night and getting up in the mornings. The manager agreed to look into the concerns raised by staff and to consider how these should be addressed to ensure the welfare of the people who live in the home and the staff who care for them.

On the day of our visit we saw that people using the service were receiving appropriate care, the home was actively recruiting new and experienced staff and the manager was making changes to shift patterns to meet the demands of the service.

We spoke with seven people who live in Attlee Court and one visitor during our visit to gain their views of the service. People told us how staff treated them respectfully and how they were given choices such as what time to get up and when to have their breakfast. One person explained “The food here is good. We have lots of choice of what to eat and when, and we are very well fed.”

One person commented “I love living here” and another said “This is a nice place to live, and it is spotless.” All the people spoken with said they were given appropriate information and support regarding their care or treatment. One person said “The care is generally very good” and another commented “We’re well looked after.”

People spoken with said they were happy with the staff working at the home. One person told us “The staff are very good” and another said “They are a good help.”

People spoken with said they had no concerns or complaints. People told us they felt able to speak out if they needed anything and believed the staff or the manager would act on their concerns. Some people said they would speak to staff members, family or friends to act on their behalf if they needed support.

We spoke with several people living in the home. Everyone we spoke to said that they were generally very happy with the home. People told us that they were happy with the care that they were receiving and that they were regularly asked if there needed to be any changes to meet their needs better. People told us that their family and friends welcomed and treated with respect.

People told us that they were happy with the food and there are a good number of choices.

They all said that they felt safe. People told us that they were happy with the way the staff in the home helped them with their medication and felt confident that the staff had the right training.

They said that the home has improved because some of the lounges have been made nicer. The bedrooms are being decorated one by one and some have had new carpet and curtains. Some people thought that some of the corridors still need decorating and the carpet looks a bit worn out.

Everyone said that there were enough staff and said that the staff were caring and helpful and treated them with respect.

The local authority Commissioners told us that the service has improved and is sustaining improvement. Confidence is growing in the regional manager as improvement is sustained.

This was an unannounced inspection carried out on the 25 June 2015.

Attlee Court provides accommodation and nursing care for up to 68 people. The home is located close to local amenities in the residential area of Normanton. Accommodation is based over two floors accessed by a passenger lift. All of the bedrooms are single occupancy and have en-suite toilet facilities. Communal lounges, dining rooms and bathing facilities are provided.

The home had a registered manager, however, on the day of our inspection the registered manager resigned from the home with immediate effect. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s safety was compromised in many areas. There were not always enough staff to meet people’s needs and keep them safe. People were not kept safe from harm as some incidents of abuse were not recognised or reported. Standards of cleanliness, hygiene and infection control practices were not consistent across the home which put people at risk. People’s medicines were not always managed safely. Individual risks had not always been assessed and identified.

Recruitment records evidenced recruitment practices were thorough and included application forms, interview notes, references from previous employers and checks to ensure staff were suitable to work with vulnerable people. We found some staff training was overdue. Staff received appropriate supervision and appraisal.

We observed some staff practices which showed a lack of respect for people and did not promote their privacy and dignity. We found care plans contained conflicting or essential information was missing about people’s care needs. We found people had access to appropriate healthcare professionals.

Whilst we saw people who used the service taking part in an enjoyable activity this was not available to everyone.

The mealtime experience was not good for some people and we found in some areas it was chaotic.

We reviewed complaints about the service and found the provider’s policy had been followed. Leadership and management of the home was ineffective and poor communication systems meant those in charge were not always aware of what was happening in the home. There were inconsistencies in how care was delivered throughout the home. The processes for monitoring the quality of care were ineffective and had not picked up the significant problems we found.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.